“Eat Well, America!”

November is American Diabetes Month and this years them is “Eat Well, America!” As the American Diabetes Association® celebrates its 75th anniversary, they want to share a timeless message—that eating well is one of life’s greatest pleasures, and enjoying delicious, healthy food helps with diabetes management. This November, the Association will show our nation how easy and joyful healthy eating can be.

Each week, the Association will share nutritious recipes selected by noted chefs and cookbook authors for every meal of the day, including snacks and special occasion treats. Not only that, but they’ll teach you how to choose, prepare, serve and eat healthy food that is both delicious and nutritious. From tip sheets to shopping lists, we’ll help you make healthy eating a fun and easy part of your daily life.

Everyone deserves to enjoy food that makes them feel happy, strong and empowered, and the Association will inspire people to eat well while also successfully managing their diabetes.

Check back for upcoming recipes (see calendar below), and be sure to share them with friends and family. It’s a great way to put good food and good health on the table.

Eat Well, America! Calendar

Week One (11/1–11/7): Breakfast
Delicious breakfast recipes that motivate you to get your busy day off to the right start.

Week Two (11/8–11/14): Snacks
Easy and satisfying snack recipes that make the walk past the vending machine a breeze.

Week Three (11/15–11/21): Lunch, Including National Healthy Lunch Day
Lunch recipes that get you through the midday hump and keep you on track through the rest of the day.

Week Four (11/22–11/28): Dinner
Seasonal dinner recipes that ensure you don’t miss out on the autumn and holiday flavors you love.

Week Five (11/29–12/5): Special Occasion Foods
Healthy special occasion options, including sweets, so you never feel deprived of your favorite treats and stay on track with good nutrition.

Link: http://Diabetesforecast.org/adm

Advancements in Insulin Therapy

This is an exciting time in Diabetes management as there are several advancements in insulin therapy available now and coming in the near future.  These therapies will provide patients with Type 1 and Type 2 diabetes with safer and more effective treatment options moving forward.  There are three therapies that we’re discussing here.

Toujeo® (Insulin Glargine 300u/ml) is a highly concentrated type of long-acting insulin that, in clinical trials, showed less risk for causing nocturnal (overnight) hypoglycemia and no increased risk for daytime hypoglycemia versus its comparator Lantus® (Insulin Glargine 100u/ml).  Toujeo® is an FDA approved therapy for Type 1 and Type 2 diabetes that allows for a smaller volume of insulin injected.  There are several ongoing clinical trials (many being done at Texas Diabetes & Endocrinology) researching other concentrated insulin therapies, as well as some ultra-long and ultra-fast acting insulin varieties.  We expect to see more of these types of insulin coming to market in the coming years.  These advancements will alter how we manage diabetes for the better.

Another FDA approved therapy is an inhaled rapid-acting insulin called Afrezza®; this is an appealing option for those who would like to avoid administering insulin via an injection or reduce the number of insulin injections administered each day.  The insulin is approved for treatment of both Type 1 and Type 2 diabetes and is administered at mealtime.  Other varieties of insulin are being researched, many pursuing alternative modes of administration, such as: oral, buccal (placement of medication between gums & cheek), transdermal (on skin ex: patches), ocular (eye drops), and intranasal (through the nose) to name a few.  It will be very interesting to see which therapies get approved and it will hopefully provide patients with better, safer insulin treatment options.

There has also been a lot of buzz about the ongoing work toward the development of an Artificial Pancreas.  This would be a continuous glucose monitoring system, which transmits data wirelessly to an insulin pump, then the pump in turn delivers insulin automatically based on a precise algorithm.  This system would allow for more accurate glycemic control, faster response time and less fluctuation in glucose levels.  This is a remarkable technological advancement and will truly revolutionize how one manages insulin-dependent diabetes.

Testosterone Deficiency and Aveed

Testosterone levels are checked in men at an increased frequency and more men are being prescribed testosterone replacement therapy than ever before.  Typical symptoms of low testosterone include fatigue, erectile dysfunction, low libido, and loss of muscle mass.

As Endocrinologists, we try to find the underlying reason for the testosterone deficiency (or Hypogonadism) prior to initiating therapy.   Often times the reason is either due to pituitary dysfunction (a gland in the brain), benign pituitary tumors or testicular dysfunction.  Some risk factors for low testosterone are chronic opioid use (a type of narcotic pain medication), head trauma, testicular trauma, or HIV.

The testosterone levels should be checked on a fasting, morning blood draw and the levels should be confirmed with a second blood draw.

The aim of testosterone therapy is to help improve quality of life by enhancing bone and muscle function and possibly other areas like mood or sexual function.  Use of testosterone replacement, like any other drug, is not without risks.   The adverse effects of testosterone replacement medication include effects on liver function tests, blood count, sleep apnea, and fertility.  It can also make undiagnosed prostate cancer grow.

Blood work should be checked on a regular basis to monitor these parameters.  There are no long-term clinical safety trials assessing cardiovascular risks however some data suggest that the risk may be increased in certain patient populations.

Testosterone medication comes in various formulations: a daily topical gel or patch, a three-month subcutaneous insertion of a pellet, or injections given every 1-2 weeks.  The traditional testosterone injections that can be given at home are injected every 1 to 2 weeks.

One of the newer injectable formulations is Aveed. It is a depot testosterone that is injected intramuscularly by a medical professional in a clinic at initiation, 4 weeks, and then every 10 weeks thereafter.  One of the serious, but rare, drug reactions associated with Aveed is pulmonary oil microemboli (a small oil droplet that can travel to the lungs) and anaphylaxis (severe allergic reactions). After each Aveed injection, the patient must be monitored in the clinic for 30 minutes for any respiratory reactions.

The Importance of Sleep for Metabolism

Why does your endocrinologist ask you how your sleep has been?

One night of sleep loss can influence several genes in the body, that can lead to metabolic effects.

According to a study recently published in the Journal of Clinical Endocrinology and Metabolism, these metabolic effects can include insulin resistance and weight gain. This was a study that looked at young adults who experienced both overnight wakefulness and decreased sleep duration. Even short-term changes in sleep were associated with a decrease in the efficiency with which the body processed sugar. Some of these changes were directly linked to changes in the way the body processes genes. A process called methylation was affected and this leads to slower metabolism.

The researchers took tissue samples, including small pieces of fatty tissues from under the skin of the study participants. They noted that the way these tissues broke down sugars and fats were slower in people who did not get a good night’s sleep. Researchers also saw reduced concentrations of the adrenal gland hormone cortisol in participants after sleep deprivation

These findings underline the importance of sleep for metabolism. Sleep requirements change from person to person, but a minimum of 7 hours a night is recommended for most people.